Background: Diabetes Mellitus and its complications have become a major public health problem around the world, with the number of patients diagnosed rising each year. Swellendam is no exception. Many of the patients, who receive their chronic medication from our clinics, have poorly controlled diabetes. Clinical audit can eliminate the gap between current and optimal clinical performance in Swellendam. The aim of this study was to improve the quality of care of diabetic patients at the chronic care clinics of the Swellendam sub district through a quality improvement process. Methods: An audit was done on the treatment and follow up of diabetic patients at Railton, Suurbraak and Buffeljagsrivier clinics in Swellendam. Standards and targets were set and data was collected retrospectively from a sample size of 95 patients. The results of the first audit were compared with the criteria and target standards. The audit team identified the standards we failed to meet and changes were made, as a result of the initial audit. To improve the quality of care of the patients and thus limiting the complications, it was set out to implement practical diabetes guidelines at our clinics to achieve this. After the changes were implemented and twelve months had past, another sample of the same 95 patients were taken and the audit was repeated. Results: The standards set were poorly achieved in the first audit. Significant improvements were noted when the secondary audit was done 12 months later. Patients who attended the clinic at least 6 times a year, improved from 40% during the first audit to 62% during the second audit. This increased the rate well above the target level of 50%. Recording of the patient’s weight at each visit remained fairly constant at 40% during the first audit and 41% during the second audit. This is still lower than the expected target level of 50%. The BMI was measured poorly. Although it improved from 6% in the first audit to 20% in the second audit, it was still far below the target level of 50%. Measuring of the Hgt levels improved well above the target level of 80%, from 78% in the first audit to 94% in the second audit. The same applies to the measuring of the blood pressure, where the first audit measured 78% and the second audit 95%. Testing of the patient’s urine was poorly adhered to, with 28% in the first and 35% in the second audit – much lower than the target level of 70%. A diet sheet was given to 93% of patients in the second audit, 21% more that in the first audit and 13% higher than the target of 80%. There was a huge improvement in the documenting of the patients’ foot exam, with 17% against 67%. In the first audit 61% of patients yearly visited the dietician, against 88% in the second audit. Again it is higher than the target of 80%. The vision test and fundoscopy were not well done, but nevertheless improved from the first audit. Vision test was done in 14% of patients in the first audit against 47% in the second audit, and the fundoscopy was done in 1% of patients against 38% in the second audit. The testing of the creatinine, lipid and HbA1c levels improved significantly in the second audit, respectively measuring 10%, 2% and 7% in the first audit, against 96%, 87% and 95% in the second, all well above the target levels of 70%. Only 24% of the patients’ random blood glucose levels were below 10 in the first audit against 44% in the second audit. This is lower than the target of 50%. The HbA1c levels were lower than 8 in only 13% of patients in the first audit, against 46% of patients in the second audit. Also it is lower than the target of 50%, but increased significantly. Conclusion: The results of the study showed how criteria-based audit can produce significant improvements in the quality of care of diabetic patients in a rural town in South Africa.

No description available.

All mothers and newborns deserve competent care and continuous support during the intrapartum period (Tinker et al., 2006:269). According to the Saving Mothers: Fifth Report on Confidential Enquiries into Maternal Deaths in South Africa, 2008-2010 (SA, 2011:4), the maternal mortality rate (MMR) is 176.22/100 000 live births (SA, 2011:4). The majority of maternal deaths are preventable and have many common preventable factors which are mostly related to the knowledge and skills of the healthcare providers and the challenges within the health care system (SA, 2011:5). The research was conducted in an attempt to make a meaningful contribution to the body of knowledge, specifically knowledge related to the experiences of women regarding the quality intrapartum care in a public hospital in Gauteng Province, and to make recommendations to enhance the quality of intrapartum care. A qualitative study design was used and data collected with the use of individual in-depth interviews. Purposive sampling was used to select participants who represent the target population. The sample used for the study included all women who had given birth within 24 hours before the interviews by normal vaginal delivery. A pilot study was conducted and the interview schedule was finalised. Sixteen individual in-depth interviews were done until data saturation had been achieved. Trustworthiness was ensured according to the principles of credibility, transferability, dependability and confirmability. A digital voice recorder was used to capture data and the data were transcribed verbatim. Field notes were written down for each interview. Data analysis was done by means of content analysis by the researcher and an independent co-coder. Themes and sub-themes were identified. The findings indicated that most of the women‟s experiences were positive regarding the quality of intrapartum care while a lesser percentage had had negative experiences. Identified areas of concern are staff attitudes, communication and staff shortages. Conclusions drawn are that women‟s experiences of quality of intrapartum care were that it is not of the highest standard. There is a need for provision of continuous emotional support during labour, improvement of staff attitudes and promotion of rooming-in, and a need not to be separated from their babies for long periods of time The research concluded with the researcher‟s recommendations for policy, nursing practice, nursing research and nursing education, for the enhancement and adherence of midwives to recommendations in improving the quality of intrapartum care in public hospitals. / MCur, North-West University, Potchefstroom Campus, 2014

Background: Quality of patient care includes both technical and non-technical elements of care, referred to as personal care. Previous work has focused on assessing the quality of technical care in prostate cancer radiotherapy, but little work has been done to assess the quality of personal care. Purpose: The purpose of this project was to create a self-administered questionnaire to measure the quality of personal care for patients undergoing radiotherapy for early-stage prostate cancer. Methods: Dimensions and candidate indicators of the quality of personal care were identified through a comprehensive literature search. The indicators were assigned to dimensions and then arranged into steps in the radiotherapy care continuum. A questionnaire was constructed using the indicators to assess patients’ views about the quality of their care as well as the importance of each indicator. Cognitive interviews were conducted with four health care professionals and eight patients to determine the clarity, comprehensiveness and appropriateness of the questionnaire. The questionnaire was then pilot tested on patients undergoing radiotherapy for early-stage prostate cancer. Results: A total of 176 indicators of the quality of personal care were initially identified representing 10 dimensions of care. Cognitive interviews identified problems with the questionnaire primarily related to the clarity and redundancy of the indicators and the appropriateness of the response categories. To reduce burden, the questionnaire was divided into three modules, corresponding to appropriate steps in the continuum of care. Each module was pilot tested on at least 10 patients with an overall response rate of 84%. Most patients responded to all indicators on the questionnaire without difficulty and without distress; however patterns of missing responses indicate a few particular indicators need revision. The results suggest that the design of the questionnaire is appropriate since patients seem to be using the range of response options that are offered. Conclusions: The results suggest that this questionnaire is feasible to administer in a clinic setting and that it does not place a large burden on patients. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2010-12-17 07:41:09.823

All mothers and newborns deserve competent care and continuous support during the intrapartum period (Tinker et al., 2006:269). According to the Saving Mothers: Fifth Report on Confidential Enquiries into Maternal Deaths in South Africa, 2008-2010 (SA, 2011:4), the maternal mortality rate (MMR) is 176.22/100 000 live births (SA, 2011:4). The majority of maternal deaths are preventable and have many common preventable factors which are mostly related to the knowledge and skills of the healthcare providers and the challenges within the health care system (SA, 2011:5). The research was conducted in an attempt to make a meaningful contribution to the body of knowledge, specifically knowledge related to the experiences of women regarding the quality intrapartum care in a public hospital in Gauteng Province, and to make recommendations to enhance the quality of intrapartum care. A qualitative study design was used and data collected with the use of individual in-depth interviews. Purposive sampling was used to select participants who represent the target population. The sample used for the study included all women who had given birth within 24 hours before the interviews by normal vaginal delivery. A pilot study was conducted and the interview schedule was finalised. Sixteen individual in-depth interviews were done until data saturation had been achieved. Trustworthiness was ensured according to the principles of credibility, transferability, dependability and confirmability. A digital voice recorder was used to capture data and the data were transcribed verbatim. Field notes were written down for each interview. Data analysis was done by means of content analysis by the researcher and an independent co-coder. Themes and sub-themes were identified. The findings indicated that most of the women‟s experiences were positive regarding the quality of intrapartum care while a lesser percentage had had negative experiences. Identified areas of concern are staff attitudes, communication and staff shortages. Conclusions drawn are that women‟s experiences of quality of intrapartum care were that it is not of the highest standard. There is a need for provision of continuous emotional support during labour, improvement of staff attitudes and promotion of rooming-in, and a need not to be separated from their babies for long periods of time The research concluded with the researcher‟s recommendations for policy, nursing practice, nursing research and nursing education, for the enhancement and adherence of midwives to recommendations in improving the quality of intrapartum care in public hospitals. / MCur, North-West University, Potchefstroom Campus, 2014

No description available.

Background: International guidelines provide recommendations for early chronic kidney disease care. This thesis was completed to 1) measure the quality of chronic kidney disease care and identify gaps, 2) identify reasons why patients do not receive recommended care, and 3) determine if these guideline-recommended practices are associated with better patient outcomes. Methods: Population-based cohort studies were conducted for studies 1, 3 and 4. Using consensus-based indicators, study 1 quantified the quality of care for patients with early chronic kidney disease. Study 2 was a qualitative descriptive study eliciting primary care physicians’ perceived enablers and barriers to follow-up laboratory testing to confirm chronic kidney disease. Study 3 assessed the association between non-steroidal anti-inflammatory drug (NSAID) use versus non-use and adverse clinical outcomes among older adults. Study 4 assessed whether routine serum creatinine and potassium monitoring (versus no monitoring) following angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) initiation among older adults associated with better outcomes. Results: In study 1, most recommendations were being followed; however, some care gaps were identified. For example, half of the patients with initial abnormal kidney test results did not receive follow-up tests. This finding prompted study 2, where enablers and barriers to this practice were identified. Providers were aware that they should be ordering follow-up tests and had the resources to do so. However, some providers perceived this practice as low priority. In study 3, NSAID use was associated with a higher risk of complications. In study 4, routine ACEi / ARB monitoring did not prevent adverse outcomes. Conclusions: This thesis provides a better understanding of care gaps for patients with early chronic kidney disease in Ontario, and reasons for one of these care gaps. This research also provides evidence to help strengthen guideline recommendations (NSAID avoidance) or refute them (ACEi / ARB monitoring). / Thesis / Doctor of Philosophy (PhD) / Chronic kidney disease is a medical condition where a person’s kidney function is permanently reduced. Family doctors are responsible for the care of patients with early chronic kidney disease. However, many patients may not be receiving the right treatments from their family doctors to keep their kidneys healthy. This research used Ontario healthcare data to identify care gaps for patients with early chronic kidney disease. Interviews were then done with family doctors to identify reasons for one of these care gaps; specifically, why doctors do not always repeat blood and urine tests to confirm if patients have chronic kidney disease. Finally, this research looked at whether providing certain treatments led to better patient outcomes. This information can be used to update current guidelines and to inform strategies which help patients with chronic kidney disease receive the best possible care.

No description available.

No description available.

O presente trabalho descreve, inicialmente, o papel desempenhado pela Secretaria de Higiene e Saúde (SHS) do Município de São Paulo, no contexto da assistência a saúde e das políticas nacionais que orientam suas atividades. Historicamente, a SHS vem atuando em duas linhas bem definidas e independentes: o atendimento às urgências e, paralelamente, a assistência materno-infantil que, face às novas diretrizes políticas, tende a se transformar em assistência integral à saúde. Como consequência das novas orientações políticas, várias tentativas têm sido realizadas no sentido de integrar essas duas linhas de atuação. Para tanto, a presente pesquisa, realizada no Posto de Assistência Médica (PAM) e no Pronto Atendimento (PA) Jardim São Jorge, localizado na zona oeste do Município de São Paulo, apresenta como proposta de trabalho a integração das ações de assistência médica individual de caráter curativo com as ações de assistência médico-sanitária. Partindo-se do pressuposto de que qualquer ação no campo da saúde depende da participação da comunidade, busca-se a forma pela qual a população recebe e utiliza os serviços localmente integrados. Nesse sentido, foram coletadas junto à clientela de ambos os serviços, informações tais como: motivo de procura, resolutividade, satisfação e outras, obtidas por meio de formulários. A análise das características das queixas, da resolutividade e da satisfação referida pela clientela, do objetivo e do processo de trabalho desses serviços, leva a conclusão de que o PAM e o PA são utilizados de forma seletiva pela clientela, visando principalmente, ao atendimento de suas necessidades diretamente relacionadas à resolução das manifestações de doença. / The present study describes, initially, the role played by the Higiene and Health Secretariat (SHS) of the City of São Paulo (Brasil), in the context of health assistance and of the national policies which govern these activities. Historically the SHS has acted within two well - defined and independent fields: emergency treatment and, parallel to this, mother and child health care. The latter, considering the new political guide-lines, is tending to be transformed into general health assistance. As a result of these new political guide-lines, various attempts have been made to integrate these two fields of activities. With this in view, this research project was carried out at the Public Health Clinic (PAM) and the Emergency Medical Service (PA) in the Jardim São Jorge, situated in the western zone of São Paulo City, and presents a working proposal for the integration of the individual medical care of a curative type and the activities of public health assistance. Taking as a starting-point that all activity in the health sector depends on community participation, this study seeks to discover how the population has received and used the geographically integrated health services. For this purpose, information was collected, by means of a questionnaire, from the users of both of these services, on the motive for the recoursing to the service, the service\'s ability to meet the need, the degree of satisfaction of the user, etc. The analysis of the above information as well as of the objective and the working method of these services, has led to the conclusion that the PAM and the PA are used by the public in a selective way, aiming at satisfying those immediate needs related to some present illnesses.